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Expert Point of View: Deepa Jagadeesh, MD, MPH


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“Although some B-cell lymphomas are highly curable, this goal remains elusive for most T-cell lymphomas (TCL). Refractory and relapsed disease post induction therapy remains a major challenge in management,” said Deepa Jagadeesh, MD, MPH, Assistant Professor, Cleveland Clinic Lerner College of Medicine, Lymphoma and Bone Marrow Transplant Program, and Taussig Cancer Institute, who reviewed two peripheral T-cell lymphoma (PTCL) studies presented at the 2020 American Society of Hematology Annual Meeting & Exposition.

As she noted, Mehta-Shah and colleagues evaluated outcomes data on 508 patients with PTCL who underwent allo-HSCT at 12 centers. For approximately two-thirds or more of patients, these procedures were reduced-intensity conditioning/nonmyeloablative transplants involving a matched related or unrelated donor for the treatment of relapsed/refractory TCL. At 5 years, half of the patients were alive and nearly 40% remained in remission.

Deepa Jagadeesh, MD, MPH

Deepa Jagadeesh, MD, MPH

Interestingly, patients with angioimmunoblastic T cell lymphoma had better outcomes (longer progression-free and overall survival) compared to PTCL not otherwise specified or anaplastic large cell lymphoma. Unfortunately, progression-free survival at 5 years in patients with cutaneous T-cell lymphoma was inferior (19% vs 44% for other subtypes), but overall survival was comparable.

“Although the sample size was small, encouraging 5-year progression-free survival was observed in certain rare and aggressive subtypes like hepatosplenic TCL (49%) and natural killer/TCL (30%). Remission status prior to transplant was a strong predictor for progression-free survival, as patients with chemosensitive disease had superior outcomes,” she noted.

“These promising results suggest that allogeneic HSCT is a potentially curative treatment in a subset of patients with relapsed or refractory TCL, as it can result in lasting remissions with acceptable toxicity. This benefit may be more distinct in certain subtypes such as angioimmunoblastic TCL. Referral to a transplant center should be considered for all patients with TCL to determine eligibility,” Dr. Jagadeesh said. 

DISCLOSURE: Dr. Jagadeesh has served in a consulting or advisory role for Atara Biotherapeutics, Kyowa Hakko Kirin, Seattle Genetics, and Verastem; has participated in a speakers bureau for Verastem; and has received institutional research funding from Seattle Genetics, Regeneron Pharmaceuticals, Debiopharm, Trillium, ADC Therapeutics, Rhizen Pharmaceuticals, AstraZeneca, and MEI Pharma.

 


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